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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by BRC on September 23, 2011, at 3:05:58
Hi,
I haven't posted here in quite a while. I used to come here daily.
I have encountered a medication question. After searching the web a little and getting conflicting results. I thought I would ask the experts here :)
Here is the question I have. My pdoc retired and I saw a psychiatric nurse practioner (I guess that is what you would call him). Anyway he was getting familiar with my case and my medications b/c he will be the one prescribing them now.
I have OCD, anxiety, and depression. But I also have a meninoma (begnign) tumor in my spine that creates constant nerve damage pain in my lower back and entire left leg.
I take 60mg of cymbalta for depression and the nerve damage. I take Luvox 100mg twice a day for the OCD, 2mg Klonopin twice a day for anxiety, 30mg Remeron for sleep, and 300mg Lyrica twice a day for nerve damage. This has been my cocktail for many years now.
This n p told me that I could actually take up to 120mg of cymbalta to help with the nerve damage pain. I though 60 was the max dose. I told him just to leave all my meds like they were and I would consider it in the future.
Is this guy crazier than I am. Is 120 mg cymalta safe with the other meds I have listed? Would 120 mg cymbalta give put me at risk for serotonin syndrone? And I am wonering if uping the dose would do anything for my nerve damage.
Any advice would be appreciated.
Thanks,
BRC
Posted by Brot on September 23, 2011, at 6:22:38
In reply to Is 120mg of Cymbalta too much, posted by BRC on September 23, 2011, at 3:05:58
well i also take 120 mg of cymbalta, which is fine.
BUT, you also take fluvoxamine.. which inhibits metabbolism of cymbalta. CYP1A2. Actually its contraindicated... but i dont know. maybe its ok. But i wouldnt take 120mg of cymbalta. i think this is way too much. maybe 30-60mg... or even less
Posted by Phillipa on September 23, 2011, at 10:36:10
In reply to Re: Is 120mg of Cymbalta too much » BRC, posted by Brot on September 23, 2011, at 6:22:38
BRC I agree with you. Luvox intensifies some meds and 200mg is a pretty high dose. I feel personally that upping cymbalta to 120mg isn't the right thing to do and you feel okay now? Phillipa
Posted by BRC on September 24, 2011, at 0:18:47
In reply to Re: Is 120mg of Cymbalta too much » BRC, posted by Brot on September 23, 2011, at 6:22:38
Thanks for your reply and your information. I didn't know about the metobolism problem. Seems like these doctors would be aware of this stuff. I have been on this regimn for years now.
Thanks again for the reply.
Posted by BRC on September 24, 2011, at 0:29:11
In reply to Re: Is 120mg of Cymbalta too much » Brot, posted by Phillipa on September 23, 2011, at 10:36:10
Thanks for the info. I remember you answering my questions years ago. Good to hear from you. I am going to stick with my old pdoc regimn. If it "aint" broke don't fix it.
I will make a not to ask this new nurse practioner about the metabolism problem and see what he thinks (he probably doesn't even know).
I have one more question. I get regular six month check ups for cholesterol b/c it is always high and I am on Lipitor. I eat right and exercise and my weight is pretty good. Also my liver enzymes always seem to be elevated. I have always told my family doc. that I thought it was my pcych meds causing the problems but he disagrees. What do you think? I don't want these meds to cause irreversible damage to my body.
Thanks again and nice hearing from you.
BRC
Posted by Phillipa on September 24, 2011, at 19:32:55
In reply to Re: Is 120mg of Cymbalta too much » Phillipa, posted by BRC on September 24, 2011, at 0:29:11
Sorry late answering just on the site. Elevated liver enzymes are not good at all. Do you have a regular doc? Who ordered the enzyme test. Cymbalta or any of the meds could cause that. Don't know a lot about lipitor. I will google it. Phillipa
Posted by Phillipa on September 24, 2011, at 19:36:25
In reply to Re: Is 120mg of Cymbalta too much » Brot, posted by BRC on September 24, 2011, at 0:18:47
Well here is lipitor. Phillipa
http://cholesterol.emedtv.com/lipitor/lipitor-liver-side-effects.html
Posted by Phillipa on September 24, 2011, at 19:50:01
In reply to Re: Is 120mg of Cymbalta too much, posted by Phillipa on September 24, 2011, at 19:36:25
Cymbalta itself can cause elevated liver enzymes. Phillipa
Posted by BRC on September 25, 2011, at 15:36:59
In reply to Re: Is 120mg of Cymbalta too much » BRC, posted by Phillipa on September 24, 2011, at 19:32:55
Thanks for the reply. Elevated liver enzymes is not good. But my family doc has been monitoring them for years and says in my case not to be too concerned. This past time he ordered a special protien test just to make sure everything was ok. The test came back normal.
Lipitor works directly on the liver since that is where cholesterol is made. So, routine liver test are a must. Also alot of the meds are filtered through the liver. Some through the kidneys. I do drink. So, the Lipitor along with all the psych meds naturally causes high liver enzymes.
Thanks for always answering my post.
BRC
Posted by Phillipa on September 25, 2011, at 18:48:15
In reply to Re: Is 120mg of Cymbalta too much » Phillipa, posted by BRC on September 25, 2011, at 15:36:59
You're welcome. But what was the special test your doc ordered? I don't understand how high liver enzymes could be okay? Phillipa
Posted by BRC on September 27, 2011, at 8:36:48
In reply to Re: Is 120mg of Cymbalta too much » BRC, posted by Phillipa on September 25, 2011, at 18:48:15
I guess there is a difference between "slightly" elevated and elevated.
The special test all I know is it was a protien test to see how your body was breaking down certain protiens.
Thanks.
BRC
Posted by pattisun16 on December 5, 2014, at 2:27:56
In reply to Re: Is 120mg of Cymbalta too much » Phillipa, posted by BRC on September 27, 2011, at 8:36:48
I'm searching thru message boards for Cymbalta users.
I take fentanyl patch, 50mcg and Norco (4/day). I have spinal stenosis and bursitis in my hips.
I am tired of getting treated like a druggie here in California. I have to almost beg my nurse to get the Hand written script and if my doctors allow me my meds earlier than 30 days the pharmacy won't fill it, even if I am traveling!! And nobody understands that some months have 31 days....
So I have to take Lyrica along with the Cymbalta to control the pain.
I hope you are doing well, thanks for your help.
Patti in California
Posted by SLS on December 5, 2014, at 8:40:27
In reply to Re: Is 120mg of Cymbalta too much, posted by pattisun16 on December 5, 2014, at 2:27:56
> I'm searching thru message boards for Cymbalta users.
>
> I take fentanyl patch, 50mcg and Norco (4/day). I have spinal stenosis and bursitis in my hips.
>
> I am tired of getting treated like a druggie here in California. I have to almost beg my nurse to get the Hand written script and if my doctors allow me my meds earlier than 30 days the pharmacy won't fill it, even if I am traveling!! And nobody understands that some months have 31 days....
>
> So I have to take Lyrica along with the Cymbalta to control the pain.
>
> I hope you are doing well, thanks for your help.
>
> Patti in CaliforniaCymbalta (duloxetine) can be a great analgesic. It does not work in the same way that fentanyl (a phenylpiperidine opioid) does. The two are complementary and, perhaps, synergistic. I really don't know.
From what I have seen, 120 mg/day of Cymbalta can be more effective than 60 mg/day in a large number of people suffering from depression. It is thought by some that there is a small risk of developing serotonin syndrome when combining fentanyl with a serotonin reuptake inhibitor drug (SSRI and SNRI) like Cymbalta, but the rate of occurrence is deemed to be rare. Two cases of SS with such a combination have been reported in the medical literature.
Because Cymbalta is so uniquely effective as an antinociceptive in the treatment of various pain disorders, I think it would be reasonable to combine it with fentanyl and become familiar with the symptoms of serotonin syndrome. If combined treatment with fentanyl becomes an issue, you can look into using a non-phenylpiperidine opioid in place of fentanyl. At this point, there are no concerns regarding serotonin syndrome when using these drugs.
- Scott
Posted by ed_uk2010 on December 5, 2014, at 11:21:55
In reply to Re: Is 120mg of Cymbalta too much » pattisun16, posted by SLS on December 5, 2014, at 8:40:27
>From what I have seen, 120 mg/day of Cymbalta can be more effective than 60 mg/day in a large number of people suffering from depression. It is thought by some that there is a small risk of developing serotonin syndrome when combining fentanyl with a serotonin reuptake inhibitor drug (SSRI and SNRI) like Cymbalta, but the rate of occurrence is deemed to be rare.
I agree that it is very rare. Rare to the extent that it's not really worth thinking about when combining these two meds. Both cause their own side effects but SS isn't a major concern. Due to the potency of fentanyl, the dose needs careful adjustment, but this is true with or without Cymbalta.
Posted by ed_uk2010 on December 5, 2014, at 11:31:48
In reply to Re: Is 120mg of Cymbalta too much » pattisun16, posted by SLS on December 5, 2014, at 8:40:27
The major opioid combinations associated with serotonin syndrome are MAOI + tramadol and MAOI + meperidine (pethidine, Demerol). The cough suppressant dextromethorphan, which is related to opioids, also interacts with MAOIs.
Tramadol combined with other serotonergic drugs eg. SSRIs, SNRI and tricyclics (eg. amitriptyline for pain) can cause side effects but serotonin syndrome of any significant severity is very uncommon. A lot of people take these allegedly contra-indicated combinations.
This is the end of the thread.
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